| NPI | 1144382227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA17411) |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health (Licence: CA CA17411) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2025-04-03 |